Y khoa - Dược - Chapter 54: Physical therapy and rehabilitation

54Physical Therapy and Rehabilitation54.1 Discuss the general principles of physical therapy.54.2 Relate various cold and heat therapies to their benefits and contraindications. 54.3 Recall hydrotherapy methods. 54.4 Name several methods of exercise therapy. Learning Outcomes54.5 Describe the types of massage used in rehabilitation therapy.54.6 Compare different methods of traction. 54.7 Carry out the procedure for teaching a patient to use a cane, a walker, crutches, and a wheelchair. 54.8 Model the steps you should take when referring a patient to a physical therapist.Learning OutcomesIntroduction Medical assistantApply cold and heat Assist with ambulationTeach basic exercises Demonstrate how to use a cane, walker, crutches, or wheelchairDiscuss with the patient specific therapies for home useGeneral Principles of Physical TherapyPhysical therapy Medical specialty treatingMusculoskeletal disordersNervous disordersCardiopulmonary disordersTreatments Patient benefitsDisordersAssisting Within a Therapeutic TeamTherapeutic team membersMedical assistantCoordinate the patient’s schedule Make referralsDocument treatments and findings Reinforce instructions for the patient Answer the patient’s questions Assisting with Patient Assessment Joint mobility testingRange of motion (ROM) – degree to which a joint is able to moveGoniometerDegree of movement compared to a standard Assisting with Patient Assessment (cont.)Muscle strength testing Determines the amount of force exerted exert with a group of musclesCompare each side of bodyGait testing – assessment of howa patient walksAssisting with Patient Assessment (cont.) Posture testing Body position and alignmentChecks spinal curvesSymmetry of alignmentApply Your KnowledgeMatch description with assessment type:___ How a person walks A. Joint mobility___ Range of motion B. Muscle strength___ Body position and alignment C. Posture___ Force exerted with a group of muscles D. Gait___ Goniometer___ Check spinal curves___ Length of strideCDCBAADANSWER:Cryotherapy and Thermotherapy CryotherapyApplying cold for therapeutic reasonsTypes Wet or dryChemical or naturalThermotherapy Applying heat for therapeutic reasonsTypes DryMoist Cryotherapy and Thermotherapy (cont.)Factors affecting useTherapy's purposeLocation and condition of affected areaPatient’s age and general health Monitor patient for signs of tissue damageBe aware of contraindicationsCryotherapy and Thermotherapy (cont.)Treatment locationCirculation or sensation impairmentTemperature toleranceElderly’s sensitivity to cold and heatPrinciples of CryotherapyConstricts blood vesselsPhysiologic responses to coldPrevents swelling Controls bleedingReduces inflammationAnesthetic effect Reduces pus formation Lowers body temperatureAdministering CryotherapyDry cold applicationsIce bags and collarsChemical ice packsWet cold applicationsCold compressesIce massagePrinciples of ThermotherapyDilates blood vessels – erythemaPhysiologic responses to heatRelieves pain and congestionReduces muscle spasmsRelaxes musclesReduces inflammation andswellingAdministering ThermotherapyDry heat therapiesChemical hot packsHeating pad Hot-water bottleHeat lampFluidotherapyAdministering Thermotherapy (cont.)Moist heat applicationsHot soakHot compressHot packParaffin bathAlternating hot and cold packsAdministering Thermotherapy (cont.)Diathermy High-frequency wave achieves deep heat penetrationTypes Ultrasound ShortwaveMicrowaveApply Your KnowledgeWhat is the main difference in the effect of cryotherapy and thermotherapy that results in the physiologic response of each?ANSWER: Cryotherapy causes blood vessels to constrict, resulting in its physiologic effects, while thermotherapy causes blood vessels to dilate.Correct!HydrotherapyUse of water to treat physical problemsWhirlpoolsWater is agitated by jets of air under pressureGenerates hydromassageRelaxes muscles Increases circulationHydrotherapy (cont.)Contrast baths2 baths, one hot and one coldAffected area is quickly moved from one to the otherUnderwater exercisesWarm swimming poolBuoyancy takes pressure off jointsApply Your KnowledgeWhat are the main effects of hydrotherapy?ANSWER: Hydrotherapy relaxes muscles, increases circulation, and improves flexibility and mobility. Super!Exercise TherapyPreventive and therapeutic benefitsFlexibilityMobilityMuscle toneStrength Primary treatment for somedisorders and sports injuriesExercise Therapy (cont.)Exercise benefits includeImprove muscle tone and strengthRegain or maintain ROM Promotes neuromuscular coordinationHelps patients to resume normal activities of daily livingRole of the Medical AssistantInformation resourceSource of support and encouragementAssist with ROMPatient instructionsTypes of ExerciseChoice based on patient’s physical conditionActive mobility Self-directed exercises Increase muscle strength and functionTypes of ExercisePassive mobility Therapist or machine moves the patient’s body partRetain ROM and improve circulationAided mobility Self-directed with using a device Retain or improve ROMTypes of Exercise (cont.)Active resistance Works against resistanceIncreases muscle strengthIsometricPatient relaxes and then contracts muscles while in a fixed positionMaintains muscle strength if immobilizedTypes of Exercise (cont.)ROM exercisesMoving each joint through its full range of motionsImproves flexibility and mobilityTypesActivePassive Electrical StimulationDelivery of controlled amounts of low-voltage electricStimulates musclesPrevents atrophy Helps in healing injured jointsRetrains a patient to use injured musclesApply Your KnowledgeMatch description with type of exercise:___ Self-directed; exercise machine A. Isometric___ Self-directed; no assistance B. Aided mobility___ Low-voltage current; stimulates C. Active resistance nerves/muscles___ Relax and contract muscles from D. Electrical  fixed position stimulation___ Exercise against counter-pressure E. Active mobility___ Move joint through full range F. ROMDEFCAYIPPEE!BANSWER:MassageBenefits Relaxation and counters effects of stress heart rate and blood pressure pain due to tight musclesImproves concentrationPromotes restful sleepRelaxes the mindMassage (cont.)Swedish MassageStimulates circulation and lymph flowFive basic strokesNeuromuscular massageTargets specific musclesReleases tensionRelieves pain and pressure on nervesApply Your KnowledgeWhat is the difference between Swedish massage and neuromuscular massage?ANSWER: Swedish massage stimulates circulation and lymph flow with five basic strokes that manipulate the body’s soft tissues. Neuromuscular massage is applied to specific muscles and helps release tension and knots, relieve pain and release pressure on nerves, and increase blood flow.AAH Yes!TractionThe pulling or stretching of the musculoskeletal system UsesCreate and maintain bone alignmentReduce and prevent joint stiffeningCorrect deformitiesReduce and relieve muscle spasmsTraction (cont.)ManualGentle pull on muscles and jointsImproves motion and decreases stiffeningStaticHarness and weightsUsed to relieve muscle spasmsTraction (cont.)Skeletal – performed for injuries requiring long traction time and heavy weightsMechanical – device that intermittently pulls and relaxes Apply Your KnowledgeTrue or False:___ Static traction uses a harness and weights to induce  muscle spasms. ___ Manual traction stretches muscles and separates joints by  gently pulling on them.___ Skeletal traction uses pulleys and weights to provide  continuous traction.___ Mechanical traction maintains constant tension on the extremity.FTTFANSWER:FANTASTIC!Mobility AidsDevices to improve patients’ ability to ambulate or move aboutMobility aid chosen depends onPatient’s disabilityMuscle coordinationStrength Age CanesStandard – provide small amount of supportTripod and quad-base Correct heightElbow bent 20-25 degreesShould not lean on canefor supportWalkersUsed by patients whoCannot walk unassistedHave balance problems Provides a sense of stabilityAdjust to proper height for patientCrutchesTransfers weight to the armsTypes Axillary Ground to axillaShort-term useLofstrand, or CanadianGround to forearmLong-term useCrutches (cont.)Measure to fitToo long Crutch palsyBack pain Too short Back painImbalanceCrutches (cont.)Crutch gaitsTripod or standing positionDetermine proper gaitSlow or fast gaitsCrutches (cont.)Four-point gaitSlow gaitBear weight on both legsStable and saveCrutches (cont.)Three-point Cannot bear weight on one legMust have good muscle coordination and arm strengthCrutches (cont.)Two-point Swing gaitSwing-to Swing-through WheelchairsType of chairDepends on patient’s disability Length of time wheelchair neededAlways ensure patient safety during transfersUse appropriate lifting techniquesReferral to a Physical TherapistReferrals Provide physician’s orderProvide patient informationTherapists Independent practitionersHospital or clinicHome health Apply Your KnowledgeWhen would a walker be an appropriate mobility device for use by your patient? ANSWER: Walkers are usually used by patients who are too weak to walk unassisted or who have balance problems.Hurray!What is the role of the medical assistant related to referrals for physical therapy ANSWER: The medical assistant may be asked to contact the therapist directly or to give the patient a written order and information about contacting the therapist. The referral must also be documented in the patient’schartIn Summary54.1 Physical therapy is a medical specialty for the treatment of musculoskeletal, nervous, and cardiopulmonary disorders using a variety of treatments, including cold, heat, water, exercise, massage, and traction. In Summary54.2 There are various types of cold and heat therapies, including dry and wet cold and heat applications. Cold and heat therapy promote healing and increase patient comfort. Contraindications to cold and heat therapies include circulation problems, pain, and hemorrhageIn Summary (cont.)54.3 Various types of hydrotherapy used to treat physical problems include whirlpools, contrast baths, and underwater exercises. 54.4 There are several methods of exercise therapy, including active mobility, passive mobility, aided mobility, and active resistance. In Summary (cont.)54.5 The two major types of massage used in rehabilitation therapy are Swedish and neuromuscular. Swedish massage uses 5 basic strokes to manipulate soft tissues. Neuromuscular massage is applied to specific muscles and helps release tension and knots, relieve pain and release pressure on nerves, and increase blood flow. In Summary (cont.)54.6 The different methods of traction used to treat physical problems include manual, static, skeletal, and mechanical54.7 The various mobility aids include canes, walkers, crutches, and wheelchairs. Specific instructions for each of these aids must be followed to reduce the possibility of patient injury during their use. In Summary (cont.)54.8 You may be asked to contact the specialist directly or to give the patient a written order and information about contacting the specialist. Keep a file with information about the therapists your office uses, noting the forms and information each therapist requiresEnd of Chapter 54Disability is a matter of perception. If you can do just one thing well, you're needed by someone.~ Martina Navratilova